Safe Limit of Shortening of the Spinal Cord in Thoracolumbar Bivertebral Column Resections: An Experimental Study in Goats
Safe Limit of Shortening of the Spinal Cord in Thoracolumbar Bivertebral Column Resections: An Experimental Study in Goats
复制标题
胸腰椎双椎体切除术中脊髓缩短的安全限度：山羊的实验研究
DOI：
10.1016/j.wneu.2019.10.140
复制
发表时间：
2020-02-01
影响因子：
2
通讯作者：
Ma, Xiangyang
中科院分区：
文献类型：
--
作者：
Yang, Haozhi;Wang, Binbin;Ma, Xiangyang
目的：明确山羊胸腰椎双椎体切除模型中脊髓缩短的安全限度。方法：选取10只健康山羊进行实验。术前拍摄X线片，测量T13、L1和初始截骨段的高度（T12下终板至L2上终板的距离）。在体感诱发电位（SSEP）监测下完成胸腰椎双椎体切除术（T13和L1）。将椎体切除后测量的 SSEP 设置为基线。 SSEP 从基线振幅下降 50% 和/或相对于基线峰值潜伏期延迟 10% 被设置为阳性结果，表明脊髓损伤。首先测量截骨间隙的初始高度，逐渐缩短脊柱，直至SSEP监测无阳性结果。然后再次记录截骨间隙的高度。当观察到脊髓的任何形态变化时，测量并记录缩短的安全限度。术后第2天采用Tarlov评分评价后肢功能。 结果：胸腰椎双椎体切除术中脊髓缩短的安全限度为35.2±2.6 mm，大致相当于平均截骨椎体高度的127.6%和初始截骨间隙高度的57.1%。 Pearson相关性检验显示，脊髓缩短的安全限度与T13高度、L1高度、T13和11平均高度以及初始截骨间隙高度相关。结论：双椎体切除术缩短距离的安全限度大致等于平均截骨椎体高度的127.6%和初始截骨间隙高度的57.1%，具有良好的相关性。相关性。而且双椎体切除术缩短距离的安全限度比单椎体切除术要长。增加切除的椎骨数量可以防止脊髓因过度缩短而损伤。
OBJECTIVE: To clarify the safe limit of shortening of the spinal cord in thoracolumbar bivertebral column resection in a goat model.METHODS: Ten healthy goats were selected for the experiment. Radiographs were taken before surgery to measure the height of T13, L1, and the initial osteotomy segment (distance from the lower end plate of T12 to the upper end plate of L2). A procedure of thoracolumbar bivertebral column resection (T13 and L1) was completed under the monitoring of somatosensory evoked potential (SSEP) monitoring. The SSEP measured after vertebral resection was set as the baseline. SSEPs decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency were set as positive results, indicating spinal cord injury. The initial height of the osteotomy gap was measured first and the spinal column was gradually shortened until the SSEP monitoring did not show a positive result. Then the height of the osteotomy gap was recorded again. The safe limit of shortening was measured and recorded when any morphologic change of the spinal cord was observed. Hindlimb function was evaluated by the Tarlov scores on day 2 postoperatively.RESULTS: The safe limit of shortening of the spinal cord in thoracolumbar bivertebral columns resection was 35.2 +/- 2.6 mm, which was roughly equal to 127.6% of the mean osteotomy vertebral height and 57.1% of the initial osteotomy gap height. Pearson correlation test showed that the safe limit of shortening of the spinal cord was correlated with the height of T13, the height of L1, the mean height of T13 and 11, and the height of the initial osteotomy gap.CONCLUSIONS: The safe limit of shortening distance of the bivertebral column resection was roughly equal to 127.6% of the mean osteotomy vertebral height and 57.1% of the initial osteotomy gap height with good correlation. Moreover, the safe limit of shortening distance of the bivertebral column resection was longer than that in single vertebral column resection. Increasing the number of vertebrae resected may prevent spinal cord injury because of excessive shortening.